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Impact of Cognitive Behavioral Therapy for Social Anxiety Disorder on the Neural Dynamics of Cognitive Reappraisal of Negative Self-beliefs: Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) is thought to enhance cognitive reappraisal in patients with SAD. Such improvements should be evident in cognitive reappraisal-related prefrontal cortex responses. OBJECTIVE: To determine whether CBT for SAD modifies cognitive reappraisal-related prefrontal cortex neural signal magnitude and timing when implementing cognitive reappraisal with negative self-beliefs. DESIGN Randomized clinical trial of CBT for SAD vs wait-list control group during a study that enrolled patients from 2007 to 2010. SETTING: University psychology department. PARTICIPANTS: Seventy-five patients with generalized SAD randomly assigned to CBT or wait list. INTERVENTION: Sixteen sessions of individual CBT for SAD. MAIN OUTCOME MEASURES: Negative emotion ratings and functional magnetic resonance imaging blood oxygen-level dependent signal when reacting to and cognitively reappraising negative self-beliefs embedded in autobiographical social anxiety situations. RESULTS During reactivity trials, compared with wait list, CBT produced (1) greater reduction in negative emotion ratings and (2) greater blood oxygen-level dependent signal magnitude in the medial prefrontal cortex. During cognitive reappraisal trials, compared with wait list, CBT produced (3) greater reduction in negative emotion ratings, (4) greater blood oxygen level-dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (5) earlier temporal onset of dorsomedial prefrontal cortex activity, and (6) greater dorsomedial prefrontal cortex-amygdala inverse functional connectivity. CONCLUSIONS AND RELEVANCE: Modulation of cognitive reappraisal-related brain responses, timing, and functional connectivity may be important brain changes that contribute to the effectiveness of CBT for social anxiety. This study demonstrates that clinically applied neuroscience investigations can elucidate neurobiological mechanisms of change in psychiatric conditions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00380731.
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“studies demonstrating altered connectivity following CBT between amygdala and dmPFC, mOFC and vl/dlPFC (Goldin et al., 2013; Goldin et al., 2014; Månsson et al., 2013)”
From Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder. (2019) · cites this paper as Goldin et al., 2013
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In the citing paper
“CBT has been shown to increase activity in the reappraisalassociated dorsolateral, ventrolateral, and medial prefrontal cortical regions.17”
From Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial (2021) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Evidence suggests that both CBT and MBSR for SAD increase recruitment of emotion regulatory brain regions.”
From Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial (2021) · cites this paper as [17]
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“Two studies comparing CBT to wait-list groups of SAD patients demonstrated treatment-related increases in i) inverse connectivity between the dmPFC and left amygdala while reappraising negative self-beliefs (Goldin et al., 2013), and ii) positive connectivity among prefrontal regions including medial PFC, dmPFC, left dACC, left dlPFC and left vlPFC when reappraising social criticism (Goldin et al.”
From Treatment for social anxiety disorder alters functional connectivity in emotion regulation neural circuitry (2017) · cites this paper as Goldin et al., 2013
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“Individuals with SAD demonstrated strengthened inverse connectivity (i.e., negative correlation in activity between two regions) between the amygdala and the dmPFC while reappraising negative self-beliefs after cognitive behavioral therapy (Goldin et al., 2013).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin et al., 2013
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“Our results are consistent with treatment studies, which have found strengthened dmPFC activation as well as inverse connectivity with the amygdala during reappraisal after cognitive behavioral therapy (Goldin et al., 2013).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin et al., 2013
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“Prior studies using the autobiographical social situation emotion regulation fMRI task have found similar reductions in negative emotion when reacting and reappraising negative self-beliefs following CBT for SAD 17 and when implementing breath-focused and meta-cognitive attention regulation following MBSR for SAD.19,22”
In the citing paper
“Both the amygdala and rostral ACC/mPFC are putative neural 'targets' of psychosocial and pharmacological treatments known to be effective in GSAD (Evans et al, 2009;Goldin et al, 2013;Klumpp et al, 2013a;Phan et al, 2013).”
From Modulation of Resting-State Amygdala-Frontal Functional Connectivity by Oxytocin in Generalized Social Anxiety Disorder (2014) · cites this paper as Goldin et al, 2013
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Metadata
- Authors
- Goldin, P. R., Ziv, M., Jazaieri, H., Hahn, K., Heimberg, R., & Gross, J. J.
- Affiliations
- Stanford University (US)
- Temple University (US)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2013-10-01
- Volume
- 70
- Issue
- 10
- Pages
- 1048
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4141477
- OpenAlex
- W2153734379
- Semantic Scholar
- 4680b233cbaeda4704483fc44cbe3e45d43f2ec4
- Cited by
- 174
- References
- 44
- Citations by year
- 2026: 14 · 2025: 12 · 2024: 5 · 2023: 11 · 2022: 14 · 2021: 12 · 2020: 10 · 2019: 10 · 2018: 21 · 2017: 12 · 2016: 19 · 2015: 17 · 2014: 16
- FWCI
- 23.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH076074)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- cognitive behavioral therapy, social anxiety disorder, cognitive reappraisal, negative self-beliefs, prefrontal cortex, dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, amygdala, negative emotions
- MeSH terms
- Anxiety Disorders, Brain Mapping, Cognition, Emotions, Humans, Psychomotor Performance, Cognitive Behavioral Therapy, Prefrontal Cortex
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